Side Effects of Radical Prostatectomy

Major advances have been made in treating prostate cancer. Still, the disease and its treatments can cause reactions and side effects. At Memorial Sloan Kettering, we understand how troubling these can be, and we’re here to help you minimize them whenever possible. Our specialists have treated thousands of men with this illness and can help you manage cancer- and treatment-related complications and protect your quality of life.

Because the prostate is located next to the muscle that controls urination and the nerves involved in erections, surgery to remove the gland can sometimes disrupt these functions.

Urination Problems

Urinary incontinence, or the loss of bladder control, sometimes happens following surgery in this delicate part of the body. It can be caused by increased pressure on the bladder, muscle spasms, or damage to the sphincter muscle, which controls bladder flow.

The good news is that bladder problems are much less common than they used to be. More than 90 percent of men who undergo surgery at MSK return to normal urinary function, usually within a few months after surgery.

About 5 to 10 percent of all men who undergo prostate surgery experience mild but permanent stress incontinence. This is a condition in which a small amount of urine passes while coughing, laughing, or exercising. This condition can be treated effectively with a regimen of pelvic exercises or with medications that reduce bladder pressure.

For many urination problems after cancer treatment, our surgeons can help.

For men who experience more severe, ongoing incontinence, our doctors perform a variety of minimally invasive and surgical procedures that can ease these symptoms. They include:

  • urethral bulking, which helps thicken the wall of the urethra (the tube through which urine leaves the body) and prevent leaking
  • surgically attaching a mesh sling to the muscle or the pelvic bone beneath the urethra to provide support and increase resistance to abdominal pressure
  • fitting an artificial urinary sphincter, a silicone rubber device, around your urethra so it can be inflated or deflated to control urination

Erectile Dysfunction

Even when surgeons use the most-advanced techniques, erectile dysfunction can occur. Also referred to as impotence, it means that you’re unable to get or maintain an erection. This happens if prostate surgery disrupts the nerves close to the prostate that control blood flow to the penis. Often, this side effect is temporary, although recovery of full erections may take as long as three years after prostate surgery.

If you experience erectile dysfunction after radical prostatectomy, our sexual medicine experts can help you to manage the side effects. Our team of physicians, nurse practitioners, and psychologists are at the forefront of research and treatment for these issues. We collaborate with your prostate cancer treatment team to minimize the impact of surgery on your sexual health. Learn more about our male sexual health services.

Selected Publications

Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002 Apr 11; 346(15):1138-44.

Bianco FJ Jr, Riedel ER, Begg CB, et al. Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol. 2005 Jun;173(6):2099-103.

Eastham JA, Kattan MW, Riedel E, et al. Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol. 2003 Dec;170(6 Pt 1):2292-5.

Zelefsky MJ, Eastham JA, Cronin AM, et al. Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol. 2010 Mar 20;28(9):1508-13.

Wibmer A, Vargas HA, Donahue TF, et al. Diagnosis of Extracapsular Extension of Prostate Cancer on Prostate MRI: Impact of Second-Opinion Readings by Subspecialized Genitourinary Oncologic Radiologists. AJR Am J Roentgenol. 2015 Jul;205(1):W73-8.

Ehdaie B, Eastham JA. Effective management of localized prostate cancer: first, do no harm. Eur Urol. 2013 Sep;64(3):379-80. doi: 10.1016/j.eururo.2013.03.035.